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General NPI Number Information
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NPI Number | 1497144141
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Entity Type | Organization
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Legal Business Name | SAYULI WONG, PSYCHOLOGIST INC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 1585 BUTTE HOUSE RD SUITE C
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City | YUBA CITY
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State | CA
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Zip | 95993-2200
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Country | US
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Telephone | 530-671-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 1585 BUTTE HOUSE RD SUITE C
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City | YUBA CITY
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State | CA
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Zip | 95993-2200
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Country | US
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Telephone | 530-671-5483
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAYULI S WONG
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Credential | PSY.D.
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Telephone | 530-683-5583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY 25264
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License Number State | CA
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